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PubMed1999

Accounting for evil and cruelty: is to explain to condone?

Analysts of evil and violence express the concern that to explain harmdoing may result in a condoning attitude toward perpetrators. An examination of research relevant to this hypothesis suggests that there are a variety of cognitive and affective processes that may produce a relatively condoning attitude toward perpetrators as a result of explaining their actions. Evidence from 3 exploratory studies supported the exonerating effects of explanations. Participants generating explicit explanations of harmdoing displayed a more condoning attitude toward pelpetrators than did those forming impressions of perpetrators without first explaining the acts. Participants reading social-psychological explanations of harmdoing also judged the researcher to be more condoning of perpetrators than those reading dispositional explanations of the same behavior. Implications of these findings are discussed.

Journal Article↗

PubMed2001

Explaining unexpected gender differences in hostility among persons seeking treatment for substance use disorders.

OBJECTIVE: Gender differences in depression and anxiety are found among patients seeking treatment for substance use disorders, but few data exist on differences in hostility. As part of a larger study describing substance abuse treatment seekers, analyses investigated whether women would be more depressed and anxious than men, but less hostile. METHOD: Data were collected at baseline from 336 outpatients (62% men) at an addiction treatment agency. Most of the outpatients (81%) had DSM-IV chart diagnoses of alcohol dependence or abuse. RESULTS: On the depression, anxiety and hostility subscales of the Brief Symptom Inventory, women had significantly higher scores than did men. When scores were converted to gender-keyed T scores standardized on a normal sample, differences in depression and anxiety were no longer significant. However, differences in hostility remained. A regression analysis indicated that hostility scores were explained not by gender, but by greater severity of adverse consequences from substance use, insomnia, lack of social support, and being married. A childhood history of physical or sexual abuse, although more common in women than men, did not explain gender differences in hostility after controlling for other variables. CONCLUSIONS: The women in this study did not appear to be more anxious and depressed than did the men after controlling for gendered population norms. However, the women were more hostile than the men. Women's greater hostility was explained not by gender per se, but by personal and social factors that were differentially distributed across genders. Treatment implications are reviewed.

Adult↗

PubMed1998

Mammography use helps to explain differences in breast cancer stage at diagnosis between older black and white women.

BACKGROUND: Older black women are less likely to undergo mammography and are more often given a diagnosis of advanced-stage breast cancer than older white women. OBJECTIVE: To investigate the extent to which previous mammography explains observed differences in cancer stage at diagnosis between older black and white women with breast cancer. DESIGN: Retrospective cohort study using the Linked Medicare-Tumor Registry Database. SETTING: Population-based data from three geographic areas of the United States included in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program (Connecticut; metropolitan Atlanta, Georgia; and Seattle-Puget Sound, Washington). PARTICIPANTS: Black and white women 67 years of age and older in whom breast cancer was diagnosed between 1987 and 1989. MEASUREMENTS: Medicare claims were used to classify women according to mammography use in the 2 years before diagnosis as nonusers (no previous mammography), regular users (> or =2 mammographies done at least 10 months apart), or peri-diagnosis users (mammography done only within 3 months before diagnosis). Information on mammography use was linked with SEER data to determine cancer stage at diagnosis. Stage was classified as early (in situ or local) or late (regional or distant). RESULTS: Black women were more likely to not undergo mammography (odds ratio [OR], 3.00 [95% CI, 2.41 to 3.75]) and to be given a diagnosis of late-stage disease (OR, 2.49 [CI, 1.59 to 3.92]) than white women. When women were stratified by previous mammography use, the black-white difference in cancer stage occurred only among nonusers (adjusted OR, 2.54 [CI, 1.37 to 4.71]). Among regular users, cancer was diagnosed in black and white women at similar stages (adjusted OR, 1.34 [CI, 0.40 to 4.51]). In logistic modeling, previous mammography alone explained about 30% of the excess late-stage disease in black women. In a separate model, previous mammography explained 12% of the excess late-stage disease among black women after adjustment for sociodemographic and comorbidity information. CONCLUSION: Differences in breast cancer stage at diagnosis between older black and white women are related to previous mammography use. Increased regular use of mammography may result in a shift toward earlier-stage disease at diagnosis and narrow the observed differences in stage at diagnosis between older black and white women.

Black or African American↗

PubMedDate not supplied

Explaining cost variations in clinical trials using severity of illness measures.

OBJECTIVE: To determine the usefulness of severity of illness measures in explaining the variation in costs observed in economic analyses of clinical trials. METHOD: Hospital costs and three severity of illness measures (Medical Illness Severity Grouping System [MedisGroups], Acute Physiology and Chronic Health Evaluation [APACHE] II, APACHE III) were calculated for patients undergoing surgical management of gastrointestinal malignancies. Regression models were developed to determine the predictive ability of the severity of illness measures on total costs and length of stay of surgical patients. RESULTS: There was not a significant reduction in the cost variance among patients after correcting for severity with use of the MedisGroups score. APACHE II scores were a better predictor of total costs, although this relationship did not reach statistical significance. As a continuous variable, APACHE III scores explained $326 of extra cost for each point on the scale, and as a categorical variable, identified those patients who were most expensive to care for and with long lengths of stay. CONCLUSION: Neither MedisGroups nor APACHE II were found to be useful in explaining cost variations in a clinical trial. The APACHE III system was more useful in discriminating resource intensive patients.

Clinical Trials as Topic↗

PubMed1982

Factors that may explain interstate differences in certificate-of-need decisions.

A major difficulty in conducting studies of the impact of certificate-of-need programs is in accounting for interstate differences in program characteristics. This paper addresses this problem by examining the empirical relationship between various characteristics of certificate-of-need programs and program decisions, measured in terms of the approvals of hospital capital projects. Aggregate data on capital expenditure approvals and net bed change approvals for 28 States are correlated with an index of each State's regulatory characteristics that was developed in an earlier study. In addition, a multivariate model of certificate-of-need approvals is estimated in which certain measures associated with the need for hospital capital in a State are introduced, along with the indices of regulatory characteristics, to explain interstate differences in regulatory characteristics, to explain interstate differences in program decisions. The results of this analysis indicate that although regulatory characteristics are significantly correlated with the relative number of new beds approved, they have little correlation with total capital expenditure approvals. Moreover, variables reflecting the need for new hospital capital in a State, such as past population growth and existing hospital capacity, appear to be more important than regulatory characteristics in explaining the relative amount of capital approvals.

Capital Expenditures↗

PubMed1999

Factors explaining the use of psychiatric services by general practices.

BACKGROUND: Referral rates from general practitioners to hospital services vary up to 25-fold, and several studies have sought reasons for this apparent inconsistency in clinical practice. However, few studies have concentrated on, or indeed included, psychiatric patients or psychiatric referral rates. AIM: To determine the effect of population, general practice, and mental health service factors on use of specialist mental health services by general practices. METHOD: Cross-sectional data from computerized records used in managing clinical care on all patients aged 16 to 64 years who had been in contact with any mental health service staff over a two-year period. Twenty-three practices in Huntingdon Health District were studied, with a list population of 87,643 patients aged 16 to 64 years, served by one inpatient ward and three community mental health teams. The main outcome measures were the relation between age-standardized utilization ratio and markers of morbidity, deprivation, community mental health provision, and practice prescribing. RESULTS: Variation between practices in the use of mental health services was relatively limited, especially compared with the use of other secondary medical and surgical services. Three factors together explained 60.8% of the variance in use between practices: a census-based index of long-term limiting illness in females registered with the practice, use of one of the three community mental health teams, and average quarterly defined daily doses of hypnotics prescribed per practice population. Relatively high prescribing of hypnotics was associated with lower service use. CONCLUSION: Population morbidity and factors in the mental health service explain a substantial part of the variation in the use of mental health services between practices. Further work is needed to replicate these findings and explore why team factors and prescribing patterns influence utilization ratios. This study underlines the importance of examining population, practice, and specialist service factors in explaining variation in the use of secondary care by general practices.

Adolescent↗

PubMed1999

Difference in body fat percentage does not explain the gender dimorphism in leptin in Asian Indians.

OBJECTIVE: Leptin is a hormone probably having regulatory function on energy intake and metabolic activities in humans. The study was done: (a) To determine the relation of leptin with the body fat% in Indians, (b) To see whether the differences in body fat accounted for the gender differences in the concentration of leptin and (c) to look for the effect of diabetes on the levels of leptin. METHODS: Glucose tolerance was determined by oral glucose tolerance test (GTT) in 87 subjects with no known history of diabetes. Leptin was estimated by radio immuno assay. Age, height, weight, waist and hip circumferences were noted. Body mass index (BMI, weight kg/height m2) and waist:hip ratio (WHR) were calculated. The body fat % was estimated by bioelectrical impedance analysis. RESULTS: Leptin correlated with log fat % and BMI, body weight and waist circumference in different categories of glucose tolerance (Pearson's correlation test). Leptin values were higher in women than in men even after correcting for the body fat % indicating that the gender dimorphism was not explained by the higher fat % in women. The geometric mean of leptin concentration in men was 3.6 ng/ml and in women 10.9 ng/ml (P < 0.0001). Leptin level were not influenced by the status of glucose tolerance. Gender showed a significant effect on leptin concentration (F = 11.0, df = 1.39, P = 0.002) after adjusting for the effect of covariates i.e. percentage of fat (log), BMI, age, WHR and 2 h plasma glucose by ANCOVA. None of the covariates except BMI (P < 0.0001) showed significant correlation with leptin. The total variance explained was 68.4%. CONCLUSION: We conclude that (1) Plasma leptin is strongly correlated to the body fat content (2) the gender dimorphism of leptin is not explained by the differences in fat percentage and (3) hyperglycemia does not influence plasma leptin levels.

Adipose Tissue↗

PubMed2002

Variance in practice emergency medical admission rates: can it be explained?

BACKGROUND: Emergency admission rates have been rising steadily in recent years, with the majority of the increase owing to emergency medical admissions. Possible causative factors include changing demography, incidence of disease, admission thresholds, multiple admissions, and appropriateness of admission. AIM: To investigate the impact of patient and practice factors on variance in general practices' emergency medical admissions rates. DESIGN OF STUDY: Multiple regression analysis relating emergency medical admission rates of general practices to patient and practice characteristics. SETTING: The study was conducted between 1996 and 1997 in the acute hospital trust serving the study area, Dundee, Scotland. METHOD: Scottish Morbidity Record 1 (SMR1) data, which contains details of all hospital consultant episodes, was used to calculate individual practices emergency medical admission rates. These rates were then standardised to an expected value of 100. Forward selection was used to find a suitable multiple regression model to predict each practice's emergency medical admission rate from practice and patient variables. RESULTS: Crude emergency medical admission rates for general practices showed a 1.8-fold variation between the top and bottom deciles. The deprivation status and age of patients explained 42% of the variance in admission rates (64% with the exclusion of one practice that had a poor fit to the model). After correcting for age and deprivation there was a 1.2-fold variation in general practices' emergency medical admission rates. CONCLUSION: The most important factors in explaining variance in general practices' emergency medical admission rates are socio-demographic, with age and deprivation explaining a large proportion of the variation. We found no evidence to support the contention that general practice factors were linked with admission rates.

Aged↗

PubMed1992

[Sudden infant death: from the unexplained to the explained].

In France, 1,300 to 1,500 infants die suddenly each year. Are these deaths explained? Most clinicians agree that in more than two-thirds of the cases death cannot be formally explained by the clinical or paraclinical context or by the findings at post-mortem examination. These infants are the victims of the "sudden infant death syndrome." This syndrome consists of a transient abnormality in the maturation of the vegetative nervous system function, upon which are superimposed non-specific elements that facilitate or precipitate death. The lack of routine examination to detect this background explains why sudden infant deaths cannot be predicted in the majority of cases. Because there is no method sufficiently accurate to diagnose the abnormality of maturation, these deaths cannot for the moment be firmly ascribed to this abnormality.

Autonomic Nervous System↗

PubMed1992

Can age-related decline in speech understanding be explained by peripheral hearing loss?

Speech audiometric scores were compared across the age range from 50 to 90 years in 137 subjects selected in such a way that average audiometric thresholds were matched across four age groups. Thus any age-related changes in speech audiometric scores could not be attributed to age-related differences in peripheral hearing sensitivity. Four speech audiometric measures were studied; phonemically-balanced words (PB), Speech Perception in Noise (SPIN) test for both high- and low-predictability sentences, and the Synthetic Sentence Identification (SSI) test. There was an age trend for all four speech measures but only the change in SSI (30%) was statistically significant. The argument that the change in SSI can be explained by subtle changes in the auditory periphery, not reflected in audiometric thresholds, is weakened by the fact that the change in SSI was greater than the change in either of the two monosyllabic word tests (PB and SPIN-low). The argument that the change in SSI can be explained by concomitant cognitive decline is not supported by correlations among SSI performance and any of several neuropsychological measures of cognitive function in the same subjects. Finally, the lack of a significant interactive effect between hearing sensitivity level and cognitive status does not support a model in which a peripherally degraded speech signal interacts with a deficit in cognitive function to produce the decline in speech audiometric scores. We conclude that the observed age-related decline in SSI performance cannot be satisfactorily explained by peripheral hearing sensitivity loss.

Aged↗

PubMedDate not supplied

Explaining body composition by some covariate factors among the elderly Bengalee Hindu women of Calcutta, India.

Understanding the changes in body composition with passage of time and factors associated with them will help to improve our knowledge and understanding about these processes and could guide in the prevention of functional limitations and formulation of better health care among the elderly. The present cross-sectional work was under taken to study the effect of age, menopause, age at first conception, educational level and physical activity in explaining body composition among 200 elderly (55 years and above) Bengalee Hindu women of Calcutta, India. Body composition measures namely percentage of body fat (PBF), fat mass index (FMI), and fat free mass index (FFMI) were calculated from skinfolds thickness using standard equations. Multiple regression analyses of body composition variables by covariate factors revealed that Age, age of onset of menopause, age at first conception, educational level and frequency of walking cumulative explains 35%, 28% and 21% of PBF, FMI and FFMI respectively. Present study revealed that beside age, both biosocial (age of onset of menopause, age at first conception, education level) and physical activity as measured by brisk walking have significant contribution in explaining body composition among elderly females. Significant negative impact of physical activity on PBF, FMI and positive impact on FFMI in the present study were also evident. Therefore, brisk walking could be useful to increase body's fat free mass.

Age Factors↗

PubMed1989

Explaining the social patterns of depression: control and problem solving--or support and talking?

Research on the social patterns of depression in the community finds consistently that high levels of education and income, being male, and being married are associated with lower levels of depression. We attempt to explain these patterns as the result of two essential social perceptions: the sense of controlling one's own life rather than being at the mercy of powerful others and outside forces, and the sense of having a supportive and understanding person to talk to in times of trouble. In theory, the sense of control reduces depression because it encourages active problem solving, and the sense of support reduces depression because it provides others to talk to. We find evidence for the first proposition: persons who feel in control of their lives are more likely to attempt to solve problems. Perceived control and problem solving decrease depression and largely explain the effects of income and education on depression. We find, however, that support has mixed effects. Support decreases depression, but talking to others when faced with a problem, which increases with the level of support, increases depression. Support explains a small part of the effect of marriage on depression. Control and support have an interactive effect on depression, suggesting that control and support can substitute for one another to decrease depression: a high level of one reduces the need for the other, and a low level of one is remedied by a high level of the other.

Adolescent↗

PubMed1989

To what extent does breastfeeding explain birth-interval effects on early childhood mortality?

This article shows that in Nepal breastfeeding almost completely explains the effects of following birth interval on childhood mortality during the first 18 months of age and partially explains the effect of following birth interval on childhood mortality between 18 and 60 months of age. Breastfeeding does not explain the effect of preceding birth interval on childhood mortality. The analysis is based on application of hazard models to data from the 1976 Nepal Fertility Survey.

Birth Intervals↗

PubMed1984

Measuring and explaining the change in life expectancies.

A set of new indices for interpreting change in life expectancies, as well as a technique for explaining change in life expectancies by change in mortality at each age group are presented in the paper. The indices, as well as the new technique for explaining the differences in life expectancies, have been tested and examples using United States life tables are presented. The technique for explaining life expectancy differentials can be used for analyzing change in mortality or mortality differentials by sex, ethnicity, region, or any other subpopulations. The technique can be applied to life expectancies at birth or temporary life expectancies between any desirable ages.

Actuarial Analysis↗

PubMed1994

Protection against natural killer cells by interferon-gamma treatment of K562 cells cannot be explained by augmented major histocompatibility complex class I expression.

Prior study has revealed that the expression of certain major histocompatibility complex (MHC) class I molecules on the membranes of normal or transformed cells can prevent natural killer (NK)-cell-mediated killing. This has been explained by either (1) the target interference model, or (2) the effector inhibition model. In both cases, MHC class I molecules are concerned but the precise mechanisms are still unclear. The erythroleukaemia K562 cell is known as a NK-sensitive target. This sensitivity has been explained mostly as being due to lack of MHC class I antigens on the K562 membrane. However, several recent studies have indicated that the expression of MHC class I antigens on the cell does not solely explain the protection against NK cells. To elucidate the mechanism of NK-cell-mediated killing, we investigated the killing profiles of the K562 cells by NK cells. Previous studies indicated that the NK-sensitive K562 cells can express some MHC class I antigens on their surface, and become protective against NK-cell killing after treatment with human interferon-gamma (hIFN-gamma). In the present study, we show that this resistance is not rendered by MHC class I expression, because addition of anti-MHC class I monoclonal antibodies (mAb) in the killing assay of hIFN-gamma-treated K562 cells, which express MHC class I antigens as the target, did not restore the sensitivity to NK cells. Moreover, we show that spontaneously occurring K562 clones which could not express MHC class I antigens even after hIFN-gamma treatment, could be protected after treatment with the cytokine. Taken together, these results strongly suggest that the susceptibility of K562 cells to NK cell killing is due to some elements distinct from those related to MHC class I antigens.

Antibodies, Monoclonal↗

PubMed1994

Asthma and atopy as diseases of unknown cause. A viral hypothesis possibly explaining the epidemiologic association of the atopic diseases and various forms of asthma.

The basic etiology of asthma and atopy is unknown. Family grouping of cases is evident and has led to the assumption that genetic predisposition to making excessive IgE responses and in some cases a genetically determined tendency to have irritable bronchi are the fundamental causes of these conditions. Interplay between these hereditary predispositions and environmental factors such as allergen exposure are thought to explain all of the characteristic findings. Many cases, however, develop without a positive family history, and there are a variety of findings not easily explained by current theory. The increasing incidence of these conditions makes it necessary to question long held assumptions and explore other hypotheses. A review of difficult to explain characteristics and epidemiology of asthma and atopy makes a hypothesis involving a transmissible agent or agents plausible enough to warrant serious consideration.

Asthma↗

PubMed1995

What explains the variation among rheumatologists in their use of prednisone and second line agents for the treatment of rheumatoid arthritis?

OBJECTIVE: To determine the extent to which characteristics of rheumatologists and their practices explain the variation in their use of prednisone and 2nd line agents for the treatment of rheumatoid arthritis (RA). METHODS: We used multiple logistic regression to examine the relationship between the use of prednisone, hydroxychloroquine, intramuscular gold, and methotrexate, and the following categories of rheumatologist characteristics: professional experience, primary payment method, practice setting, location of rheumatology training, and demographic characteristics. Our explanatory variables also included 12 patient characteristics and a random effect term. RESULTS: Much of the variation among rheumatologists in the use of these agents is explained by the rheumatologist characteristics. Depending on the agent, professional experience explained 15 to 54%, payment method 3 to 27%, practice setting 6 to 39%, training location 12 to 53%, and demographic characteristics 3 to 23% of the rheumatologist associated variation in use of each agent. CONCLUSION: There are identifiable characteristics of rheumatologists and their practices that strongly influence their treatment decisions for RA. These findings have important policy implications.

Anti-Inflammatory Agents↗

PubMed2026

From prediction to mechanism: Explainable AI uncovers plasma and CSF proteomic signatures of Alzheimer's disease.

Alzheimer's disease (AD) plasma and cerebrospinal fluid (CSF) proteomics can distinguish AD from cognitively normal controls, but the generalizability of machine learning performance and the recurrence of biological signals across datasets require cautious interpretation. We developed an explainable artificial intelligence framework spanning two fluids and four ADNI proteomic datasets, covering 2082 modality specific samples, all analysed internally within ADNI. Phase 1 analysed plasma using a 119 analyte NULISA and targeted UPENN panel (n = 727; 216 CE, 511 controls). Phase 2 extended the analysis to CSF using SOMAscan7k, TMT-MS and targeted SET2, with Elecsys Aβ42, Aβ40, total tau and p-tau181 as anchor biomarkers. Only SOMAscan was subject-independent relative to Phase 1 plasma; TMT-MS and SET2 overlapped with Phase 1 for 96.0% and 97.7% of subjects and therefore are not independent replication cohorts. Under subject-level splits with fold internal preprocessing, we compared Elastic Net, Explainable Boosting Machines and gradient boosted trees with SHAP-based explanations. Among the candidate pipelines, we selected the pipeline with the highest held-out test ROC AUC for each platform; the selected values were 0.927 in plasma and 0.954-0.973 across the three CSF datasets. Because the same held out test performance was used for pipeline selection and headline reporting, these are optimistically selected single-holdout estimates, not unbiased estimates of generalizable or clinical performance. Explanations identified five recurring biological axes within ADNI: cholinergic (ACHE), tau/14-3-3 (YWHAG, YWHAZ, YWHAB, YWHAE), neuro-axonal (NEFL, NEFH), microglial/complement (CHIT1, SMOC1, CHI3L1, C7, CFH) and synaptic (NPTXR, NPTX2, DLG4, SYT5, VSNL1, ELAVL2). CSF analyses showed synaptic vesicle-cycle enrichment (q = 2 × 10-6), and CSF YWHAG correlated strongly with total tau (ρ = 0.87). Cross-fluid directional concordance was modest overall (54-57%) but increased to 73-80% among mapped analyte/protein rows reaching q < 0.05 in CSF. These findings provide hypothesis-generating, internally supported evidence within ADNI. Independent external cohorts with locked pipelines are required to evaluate generalizable performance and biological reproducibility; the overlapping TMT-MS and SET2 analyses should not be interpreted as independent replication.

Alzheimer Disease↗